Trastuzumab plus Adjuvant Chemotherapy for Operable HER2-Positive Breast Cancer
Edward H. Romond, M.D., Edith A. Perez, M.D., John Bryant, Ph.D., Vera J. Suman, Ph.D., Charles E. Geyer, Jr., M.D., Nancy E. Davidson, M.D., Elizabeth Tan-Chiu, M.D., Silvana Martino, D.O., Soonmyung Paik, M.D., Peter A. Kaufman, M.D., Sandra M. Swain, M.D., Thomas M. Pisansky, M.D., Louis Fehrenbacher, M.D., Leila A. Kutteh, M.D., Victor G. Vogel, M.D., Daniel W. Visscher, M.D., Greg Yothers, Ph.D., Robert B. Jenkins, M.D., Ph.D., Ann M. Brown, Sc.D., Shaker R. Dakhil, M.D., Eleftherios P. Mamounas, M.D., M.P.H., Wilma L. Lingle, Ph.D., Pamela M. Klein, M.D., James N. Ingle, M.D., and Norman Wolmark, M.D.
Background We present the combined results of two trials thatcompared adjuvant chemotherapy with or without concurrent trastuzumabin women with surgically removed HER2-positive breast cancer.
Methods The National Surgical Adjuvant Breast and Bowel Projecttrial B-31 compared doxorubicin and cyclophosphamide followedby paclitaxel every 3 weeks (group 1) with the same regimenplus 52 weeks of trastuzumab beginning with the first dose ofpaclitaxel (group 2). The North Central Cancer Treatment Grouptrial N9831 compared three regimens: doxorubicin and cyclophosphamidefollowed by weekly paclitaxel (group A), the same regimen followedby 52 weeks of trastuzumab after paclitaxel (group B), and thesame regimen plus 52 weeks of trastuzumab initiated concomitantlywith paclitaxel (group C). The studies were amended to includea joint analysis comparing groups 1 and A (the control group)with groups 2 and C (the trastuzumab group). Group B was excludedbecause trastuzumab was not given concurrently with paclitaxel.
Results By March 15, 2005, 394 events (recurrent, second primarycancer, or death before recurrence) had been reported, triggeringthe first scheduled interim analysis. Of these, 133 were inthe trastuzumab group and 261 in the control group (hazard ratio,0.48; P<0.0001). This result crossed the early stopping boundary.The absolute difference in disease-free survival between thetrastuzumab group and the control group was 12 percent at threeyears. Trastuzumab therapy was associated with a 33 percentreduction in the risk of death (P=0.015). The three-year cumulativeincidence of class III or IV congestive heart failure or deathfrom cardiac causes in the trastuzumab group was 4.1 percentin trial B-31 and 2.9 percent in trial N9831.
Conclusions Trastuzumab combined with paclitaxel after doxorubicinand cyclophosphamide improves outcomes among women with surgicallyremoved HER2-positive breast cancer. (ClinicalTrials.gov numbers,NCT00004067
[ClinicalTrials.gov]
and NCT00005970
[ClinicalTrials.gov]
.)
Source Information
From the National Surgical Adjuvant Breast and Bowel Project, Pittsburgh (E.H.R., J.B., C.E.G., E.T.-C., S.P., S.M.S., L.F., V.G.V., G.Y., A.M.B., E.P.M., N.W.); University of Kentucky, Lexington (E.H.R.); North Central Cancer Treatment Group, Rochester, Minn. (E.A.P., V.J.S., T.M.P., L.A.K., D.W.V., R.B.J., S.R.D., W.L.L., J.N.I.); Mayo Clinic Jacksonville, Jacksonville, Fla. (E.A.P.); University of Pittsburgh, Pittsburgh (J.B., G.Y.); Mayo Clinic, Rochester, Minn. (V.J.S., T.M.P., D.W.V., R.B.J., W.L.L., J.N.I.); Allegheny General Hospital, Pittsburgh (C.E.G., N.W.); Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (N.E.D.), the Cancer Research Network, Plantation, Fla. (E.T.-C.); Angeles Clinic and Research Institute, Santa Monica, Calif. (S.M.); Norris Cotton Cancer Center, DartmouthHitchcock Medical Center, Lebanon, N.H. (P.A.K.); Cancer Therapeutics Branch, National Cancer Institute, Bethesda, Md. (S.M.S.); Kaiser Permanente Medical Center Northern California, Vallejo (L.F.); Oncology Associates of Cedar Rapids, Cedar Rapids, Iowa (L.A.K.); University of Pittsburgh Cancer Institute, Pittsburgh (V.G.V.); Wichita Community Clinical Oncology Program, Wichita, Kans. (S.R.D.); Aultman Health Foundation, Canton, Ohio (E.P.M.); and Genentech, South San Francisco, Calif. (P.M.K.). Drs. Romond and Perez contributed equally to the article.
Address reprint requests to Dr. Geyer at the Allegheny Cancer Center, 5th Fl., 320 E. North Ave., Pittsburgh, PA 15212, or at cgeyer{at}wpahs.org.
Trastuzumab in Breast Cancer
Gilbert S. G., Banna G. L., Santoro A., Gounaris I. G., Katsumata M., Drebin J. A., Greene M. I., Mastrianni D. M., Mano M., Cameron D., Gelber R. D., the HERA Trial Study Team , Bryant J., Romond E., Perez E. A., Hortobagyi G. N., Barron H.
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N Engl J Med 2006;
354:640-644, Feb 9, 2006.
Correspondence
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20: 816-827
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BROOM, R. J., TANG, P. A., SIMMONS, C., BORDELEAU, L., MULLIGAN, A. M., O'MALLEY, F. P., MILLER, N., ANDRULIS, I. L., BRENNER, D. M., CLEMONS, M. J.
(2009). Changes in Estrogen Receptor, Progesterone Receptor and Her-2/neu Status with Time: Discordance Rates Between Primary and Metastatic Breast Cancer. Anticancer Res
29: 1557-1562
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Contractor, K. B., Aboagye, E. O.
(2009). Monitoring Predominantly Cytostatic Treatment Response with 18F-FDG PET. JNM
50: 97S-105S
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Kataja, V., Castiglione, M., On behalf of the ESMO Guidelines Working Group,
(2009). Primary breast cancer: ESMO Clinical Recommendations for diagnosis, treatment and follow-up. Ann Oncol
20: iv10-iv14
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Borczuk, A. C., Toonkel, R. L., Powell, C. A.
(2009). Genomics of Lung Cancer. Proc Am Thorac Soc
6: 152-158
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Sparano, J. A., Moulder, S., Kazi, A., Coppola, D., Negassa, A., Vahdat, L., Li, T., Pellegrino, C., Fineberg, S., Munster, P., Malafa, M., Lee, D., Hoschander, S., Hopkins, U., Hershman, D., Wright, J. J., Kleer, C., Merajver, S., Sebti, S. M.
(2009). Phase II Trial of Tipifarnib plus Neoadjuvant Doxorubicin-Cyclophosphamide in Patients with Clinical Stage IIB-IIIC Breast Cancer. Clin. Cancer Res.
15: 2942-2948
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Gong, Y., Sweet, W., Duh, Y.-J., Greenfield, L., Fang, Y., Zhao, J., Tarco, E., Symmans, W. F., Isola, J., Sneige, N.
(2009). Chromogenic In Situ Hybridization Is a Reliable Method for Detecting HER2 Gene Status in Breast Cancer: A Multicenter Study Using Conventional Scoring Criteria and the New ASCO/CAP Recommendations. Am J Clin Pathol
131: 490-497
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Korn, E. L., Freidlin, B., Mooney, M.
(2009). Stopping or Reporting Early for Positive Results in Randomized Clinical Trials: The National Cancer Institute Cooperative Group Experience From 1990 to 2005. JCO
27: 1712-1721
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Sargent, D.
(2009). Early Stopping for Benefit in National Cancer Institute-Sponsored Randomized Phase III Trials: The System Is Working. JCO
27: 1543-1544
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Lennon, S., Barton, C., Banken, L., Gianni, L., Marty, M., Baselga, J., Leyland-Jones, B.
(2009). Utility of Serum HER2 Extracellular Domain Assessment in Clinical Decision Making: Pooled Analysis of Four Trials of Trastuzumab in Metastatic Breast Cancer. JCO
27: 1685-1693
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Leary, A. F., Hanna, W. M., van de Vijver, M. J., Penault-Llorca, F., Ruschoff, J., Osamura, R. Y., Bilous, M., Dowsett, M.
(2009). Value and Limitations of Measuring HER-2 Extracellular Domain in the Serum of Breast Cancer Patients. JCO
27: 1694-1705
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Dolle, J. M., Daling, J. R., White, E., Brinton, L. A., Doody, D. R., Porter, P. L., Malone, K. E.
(2009). Risk Factors for Triple-Negative Breast Cancer in Women Under the Age of 45 Years. Cancer Epidemiol. Biomarkers Prev.
18: 1157-1166
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Ross, J. S., Slodkowska, E. A., Symmans, W. F., Pusztai, L., Ravdin, P. M., Hortobagyi, G. N.
(2009). The HER-2 Receptor and Breast Cancer: Ten Years of Targeted Anti-HER-2 Therapy and Personalized Medicine. The Oncologist
14: 320-368
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Houshmandi, S. S., Emnett, R. J., Giovannini, M., Gutmann, D. H.
(2009). The Neurofibromatosis 2 Protein, Merlin, Regulates Glial Cell Growth in an ErbB2- and Src-Dependent Manner. Mol. Cell. Biol.
29: 1472-1486
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Ignatiadis, M., Desmedt, C., Sotiriou, C., de Azambuja, E., Piccart, M.
(2009). HER-2 as a Target for Breast Cancer Therapy. Clin. Cancer Res.
15: 1848-1852
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Sauter, G., Lee, J., Bartlett, J. M.S., Slamon, D. J., Press, M. F.
(2009). Guidelines for Human Epidermal Growth Factor Receptor 2 Testing: Biologic and Methodologic Considerations. JCO
27: 1323-1333
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Stokoe, C.
(2009). Adapting Practice in the Face of New Data. J Oncol Pract
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Iverson, A. A., Gillett, C., Cane, P., Santini, C. D., Vess, T. M., Kam-Morgan, L., Wang, A., Eisenberg, M., Rowland, C. M., Hessling, J. J., Broder, S. E., Sninsky, J. J., Tutt, A., Anderson, S., Chang, S.-Y. P.
(2009). A Single-Tube Quantitative Assay for mRNA Levels of Hormonal and Growth Factor Receptors in Breast Cancer Specimens. J. Mol. Diagn.
11: 117-130
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Anton, A., Ruiz, A., Segui, M. A., Calvo, L., Munoz, M., Lao, J., Sancho, F., Fernandez, L.
(2009). Phase I clinical trial of liposomal-encapsulated doxorubicin citrate and docetaxel, associated with trastuzumab, as neo-adjuvant treatment in stages II and IIIA, HER2-overexpressing breast cancer patients. GEICAM 2003-03 study. Ann Oncol
20: 454-459
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MIYAMOTO, S., FUKAMI, T., YAGI, H., KUROKI, M., YOTSUMOTO, F.
(2009). Potential for Molecularly Targeted Therapy against Epidermal Growth Factor Receptor Ligands. Anticancer Res
29: 823-830
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Sargent, D., Sobrero, A., Grothey, A., O'Connell, M. J., Buyse, M., Andre, T., Zheng, Y., Green, E., Labianca, R., O'Callaghan, C., Seitz, J. F., Francini, G., Haller, D., Yothers, G., Goldberg, R., de Gramont, A.
(2009). Evidence for Cure by Adjuvant Therapy in Colon Cancer: Observations Based on Individual Patient Data From 20,898 Patients on 18 Randomized Trials. JCO
27: 872-877
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Russell, N. S., Kunkler, I. H., van Tienhoven, G., Canney, P. A., Thomas, J., Bartlett, J., van de Vijver, M. J., Belkacemi, Y., Yarnold, J. R., Barrett-Lee, P. J.
(2009). Postmastectomy Radiotherapy: Will the Selective Use of Postmastectomy Radiotherapy Study End the Debate?. JCO
27: 996-997
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Partridge, A. H., Winer, E. P.
(2009). Sharing Study Results With Trial Participants: Time for Action. JCO
27: 838-839
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Dawood, S., Broglio, K., Kau, S.-W., Green, M. C., Giordano, S. H., Meric-Bernstam, F., Buchholz, T. A., Albarracin, C., Yang, W. T., Hennessy, B. T.J., Hortobagyi, G. N., Gonzalez-Angulo, A. M.
(2009). Triple Receptor-Negative Breast Cancer: The Effect of Race on Response to Primary Systemic Treatment and Survival Outcomes. JCO
27: 220-226
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Coxon, A., Bush, T., Saffran, D., Kaufman, S., Belmontes, B., Rex, K., Hughes, P., Caenepeel, S., Rottman, J. B., Tasker, A., Patel, V., Kendall, R., Radinsky, R., Polverino, A.
(2009). Broad Antitumor Activity in Breast Cancer Xenografts by Motesanib, a Highly Selective, Oral Inhibitor of Vascular Endothelial Growth Factor, Platelet-Derived Growth Factor, and Kit Receptors. Clin. Cancer Res.
15: 110-118
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Cortes, J., Di Cosimo, S., Climent, M. A., Cortes-Funes, H., Lluch, A., Gascon, P., Mayordomo, J. I., Gil, M., Benavides, M., Cirera, L., Ojeda, B., Rodriguez, C. A., Trigo, J. M., Vazquez, J., Regueiro, P., Dorado, J. F., Baselga, J., on behalf of the Spanish Breast Cancer Cooperative,
(2009). Nonpegylated Liposomal Doxorubicin (TLC-D99), Paclitaxel, and Trastuzumab in HER-2-Overexpressing Breast Cancer: A Multicenter Phase I/II Study. Clin. Cancer Res.
15: 307-314
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